Cocaine has a transient central vagotonic effect producing bradycardia that quickly resolves and may not be clinically appreciated. More commonly, cocaine produces tachydysrhythmias, such as sinus tachycardia and atrial fibrillation, as well as ventricular tachycardia and ventricular fibrillation. Both cocaine and lidocaine

(lignocaine) have type I antidysrhythmic effects and possess proconvulsant activity associated with sodium-channel blockade. Hypertonic sodium bicarbonate is the agent of choice for wide-complex tachydysrhythmias (NeJso.D,an.d,.d.OfLm.┬žD 1995).

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